INTRODUCTION: Neonatal hyperbilirubinemia is a common problem and may cause important mortality and morbidity when early recognition and appropriate management was not recognized. We aimed to asses the etiology of neonates who had exchange transfusion.METHODS: Between January 2012 and January 2015, infants who were admitted to Izmir Tepecik Training and Research Hospital due to hyperbilirubinemia and underwent exchange transfusion were included. Demographic characteristics, laboratory parameters, exchange complications and development of bilirubin encephalopathy was noted. Cases with bilirubin encephalopathy were compared with non-encephalopathic ones. RESULTS: 27 infants were included into trial and 59.3% of the cases were male and 55.6% were born with caesarean section. The mean gestational age of the infants was 36.5 ± 3.1 weeks and the mean birth weight was 2912.5 ± 759 grams. The mean age at the time of admission was 34.2 ± 54.2 hours and 81% of infants had exchange transfusion in the first 24 hours and ABO incompatibility was found in 40.7% and Rh incompatibility in 33%. Total bilirubin and platelet counts decreased after exchange transfusion, leading to a statistical difference (p <0.05). The most common complication was hypocalcemia. Neurological effects of bilirubin encephalopathy were detected in 25.9% of the cases but there was no statistical difference in terms of demographic, etiologic and laboratory data..DISCUSSION AND CONCLUSION: Indirect hyperbilirubinemia is an important health problem affecting the neonatal period and unfortunately neurotoxicity due to hyperbilirubinemia still remains important. It is very important to detect infants who are at risk and they have to be followed closely.